anemia

Question 1

anemia

Answer 1

not enough rbc
classified by morphology or etiology (hemorrhage, hemolytic, nutrition def, aplastic)
caused by decreased rbc production, blood loss, increased rbc destruction

Question 2

causes of decreased rbc production

Answer 2

deficient nutrients: Fe, folate, b12
decreased erythropoietin: CKD
decreased Fe available: liver issues

Question 3

blood loss

Answer 3

post sx - expected
chronic: bleeding duodenal ulcer, colorectal cancer, liver disease, gastritis, menstrual flow (may be asymp and just not feel great), hemorrhoids; more insidious (sneak up)
acute: acute trauma, ruptured aortic aneurism or other blood vessel, GI bleed (peptic ulcer or ulcerative colitis - maybe recheck this?); sudden onset, cardiac instability, no time for body to compensate

Question 4

increased rbc destruction

Answer 4

hemolysis - sickle cell, meds, incompatible blood, trauma

Question 5

anemia - decreased production of rbc

Answer 5

decreased hgb synthesis - Fe deficiency anemia
defective DNA synthesis (megaloblastic anemias): cobalamin (b12) def - can include pernicious anemia (autoimmune) and most common cause of b12 def; folate def
decreased # of rbc precursors (at red marrow): aplastic anemias, chronic disease (renal fail), meds (chemo)

Question 6

megaloblastic

Answer 6

impaired DNA synthesis
b12 and folate def
macrocytic and abn -> fragile cell membrane and therefore easily destroyed

Question 7

s of anemia

Answer 7

depend on how fast it happens and how low it goes
severe s result from not enough o2 to heart (fainting, chest pain, angina, heart attack, worsening CHF
pallor, fatigue, lethargy, malaise, depression, impaired cognition, impaired memory, reduced exercise tolerance, SOB, changed stool color, dizzy, hypoT, heart palpitations, tachy, impaired libido, impotence, insomnia, enlarged sleen, paleness, cold, insomnia, leg cramps, HA

Question 8

mild s of anemia

Answer 8

asymp to mild s with activity
10-14

Question 9

moderate s of anemia

Answer 9

more cardiopulmonary s, may occur at rest
6-10

Question 10

severe s of anemia

Answer 10

many body systems involved, s at rest
<6

Question 11

reasons for cm

Answer 11

decreased O2 to muscles causes weakness
decreased E production causes fatigue
blood is redistributed (away from periphery) causing pallor in nails, palms, face, conjunctiva
increase in CO causes tachy and palpitations
increased secretion of erythropoietin causes bone pain
cardiac muscle hypoxia causes angina/MI, HF
overall hypoxia causes dyspnea and tachypnea

Question 12

Fe deficiency: causes

Answer 12

inadequate diet, gut abs, blood loss (menstruation) or hemolysis

Question 13

Fe deficiency: cm

Answer 13

can be asymp if chronic, pallor of conjunctiva (should have demarcation in normal people, anemic lose this)
epithelial atrophy: glossitis (inflam of tongue, red, sore, smooth), chelitis (inflam of lips, angular = corner of mouth), brittle hair and nails (koilonychia -> spoon nails)
pica: pagophagia (ice)

Question 14

Fe deficiency: morphology

Answer 14

micro and hypo

Question 15

cobalamin b12 deficiency

Answer 15

IF secreted by parietal cells in gastric mucosa -> needed for b12 abs
no IF = pernicious anemia - autoimmune
history of bowel sx of malabs, strict vegans, OH abuse, gastrectomy

Question 16

cobalamin b12 deficiency: cm

Answer 16

GI: n/v, anorexia, abd pain, glossitis, chelitis
B12 specific!! NM: weak, paresthesia (numb/tingle in hands and feet), reduced vibratory/position sense, ataxia (uncoord), impaired thought process

Question 17

cobalamin b12 deficiency: morphology

Answer 17

macro-normo

Question 18

folate deficiency: rf

Answer 18

typically not abs problem
decreased intake: diet def and OH abuse
increased need: preg

Question 19

folate deficiency: cm

Answer 19

insidious, similar to b12
no neuro problems -> help differentiate

Question 20

folate deficiency: morphology

Answer 20

macro-normo

Question 21

aplastic

Answer 21

results in pancytopenia (plt, wbc, rbc)
rf: mostly ido, autoimmune possibly?
cm: s/s anemia (fatigue), s/s leukopenia (infection), s/s thombocytopenia (bleeding)
maybe look those up!
dx with bone marrow biopsy
morph: normo-normo just not enough

Question 22

nursing problems with anemia

Answer 22

activity intolerance (HR increased, palpitations, SOB) and/or fatigue
altered nutrition: less than body req or malN r/t inadequate intake or abs
alpastic: risk for bleed, infection, fatigue

Question 23

collab care for anemia

Answer 23

treat cause: malN (increase intake), OH abuse (stop), abs issues (megadosese b12 PO or parenteral injections)
if cause is due to blood loss find and treat source of bleed (scope, occult)
med supplement: vits and minerals (ferrous sulfate, b12, folate); erythropoiesis stim agents (epoetin alfa)
teach foods high in def

Question 24

nc for Fe

Answer 24

oral best: inexpensive and convenient, used to be 3-4/day now 1 ok
best abs as ferrous sulfate in duodenum (avoid enteric coated or XL), in acid so 1 hr prior to meal (can take with food first few weeks for GI SE - n), undiluted liquid can stain teeth (straw), dextran can be IV and IM (use z-track bc stain skin), can turn stools black -> not melena or blood (which would be malodorous, sticky and tacky) just colored by Fe and expected finding so teach!
other SE: heartburn, c!, d
IV dextran has risk of fatal anaphylaxis so start slow and be reaty

Question 25

nc for b12

Answer 25

PO/IM/SQ/intranasal
IM preferred if severe def or neuro S
PO and IM similar effects if 1) some IF is present (so not pernicious) and 2) megadoses are given (really low abs - 1-4%)
take for life (pernicious)

Question 26

nc for folate

Answer 26

PO
no SE

Question 27

nc for erythropoietin

Answer 27

synthetic, esp common with renal disease and cancer
often given with Fe
IV/SQ 3/wk
SE: lots, weigh advant/disadvant, discontinue when hgb >10 (black box! = CV problems)

Question 28

other nc

Answer 28

monitor labs, for s of hypoxemia, VS and o2
assess neuro (need b12)
o2 therapy, provide rest, keep warm (no heating pads if risk of paresthesia), blood trasF if severe enough (PRBCs)

Question 29

foods high in Fe

Answer 29

liver, eggs, dried fruits, legumes, potatoes, dark green leafy, whole grain/enriched bread/cereals
give with vit C

Question 30

foods high in b12

Answer 30

only in animal products (issues with strict vegans!)
red meats (liver), enriched grain products, milk and dairy, fish, eggs

Question 31

foods high in folate

Answer 31

green leafy, legumes, whole grain, OJ, nuts

Question 32

polycythemia

Answer 32

abnormal increase in serum hgb, hct, rbcs

Question 33

polycythemia classified

Answer 33

relative: low plasma V/dehyd -> false high hct
primary: aka vera, genetic (at some point in life), not preventable, chronic (need ongoing eval and support)
secondary: COPD (most common, compensatory to tissue hypoxia), also high altitude

Question 34

polycythemia: cm

Answer 34

increase in blood viscosity and volume
htn -> HA, decreased [], ruddy face, possible cyanosis of lips, nails, mucous membranes
complications of decrease BV = DVT, hemorrhage, angina, cerebral insuff and TIAs, stroke! (all due to decreased perfusion to brain and heart)
hypermetabolic bc increase in tissue viscosity and BV: night sweats and weight reduction
increase in rbc, H+H: pruritus exacerbated by hot water, pain in fingers and toes

Question 35

polycythemia collab care

Answer 35

tm directed at @ decreasing blood volume and viscosity
phlebotomy (300-500 mL/every other day initially and then every few months), goal is to keep hct <42 F and 45 M
hydration
anticoags (decrease plt)
avoid immobility (clotting!)
antihistamine for pruritus -> diphenhydramine